Utility of Horizontal Sections of Scalp Biopsies in Differentiating between Androgenetic Alopecia and Alopecia Areata

Yadav, Deepika; Khandpur, Sujay; Ramam, M; Singh, Manoj Kumar; Sharma, Vinod

doi:10.1159/000490459

Cited by 7 publications

(3 citation statements)

References 26 publications

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“…In a recent prospective study 7 of 52 AA and PHL horizontal biopsy specimens, peribulbar infiltrates were also identified in approximately two‐thirds of cases. The authors suggest the use of several histopathologic features to distinguish AA from PHL when peribulbar infiltrates are sparse or absent on routine sections.…”

Section: Discussionmentioning

confidence: 97%

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A comparative study of histopathologic features in alopecia areata and pattern hair loss

et al. 2023

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Background: When peribulbar infiltrates are absent, other histopathologic findings are necessary to distinguish alopecia areata (AA) from pattern hair loss (PHL). The purpose of this study is to determine which histopathologic features are most useful for differentiation.Methods: A retrospective slide review was conducted of AA and PHL scalp biopsy specimens from 2014 to 2019 at a tertiary referral center.Results: Ninety-six cases were retrieved, of which 38 were AA. Peribulbar infiltrates were identified in 24 AA (63.2%) cases. A catagen/telogen shift was observed more frequently in AA than PHL (25 cases, 65.5% vs. 10 cases, 17.2%; p ≤ 0.0001). Lymphocytes (4 cases, 10.5% vs. 1 case, 1.7%; p = 0.058) and melanin (25 cases, 65.8% vs. 5 cases, 8.6%; p ≤ 0.0001) in fibrous tracts were more common in AA. Apoptotic bodies within vellus hairs were more frequently identified in AA (32 cases, 84.2% vs. 37 cases, 63.8%; p = 0.030). Small dystrophic follicles were also more common in AA (16 cases, 42.1% vs. 1 case, 1.7%; p < 0.0001).Conclusions: Common features of AA other than peribulbar infiltrates include a catagen/telogen shift, melanin in fibrous tracts, and small dystrophic follicles. Practitioners should consider these features when distinguishing AA from PHL in specimens without peribulbar infiltrates. The retrospective design limits our ability to exclude multifactorial alopecia, such as telogen effluvium.

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Section: Discussionmentioning

confidence: 97%

“…); (6) follicular miniaturization (M.V. ); (7) apoptotic bodies within vellus hairs (M.V. ); and (8) small dystrophic (anagen) follicles (D.E.).…”

Section: Methodsmentioning

confidence: 99%

A comparative study of histopathologic features in alopecia areata and pattern hair loss

et al. 2023

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“…As Table 1 demonstrates, some findings have various synonyms. For instance, "honeycomb pigment pattern" 7,8 has seven synonyms, [9][10][11][12][13][14][15][16][17] while "perifollicular scales" 7,10,17,18 has five. 11,12,[19][20][21] This tendency becomes apparent in the descriptions of the findings associated with CA.…”

Section: Integration Of the Terminology Definitions And Synonymsmentioning

confidence: 99%

Update on trichoscopy: Integration of the terminology by systematic approach and a proposal of a diagnostic flowchart

Kinoshita‐Ise

Sachdeva

2021

The Journal of Dermatology

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Trichoscopy represents a non‐invasive diagnostic modality widely used in daily practice. Despite the common perception that this technique has been fairly established, some key issues remain to be addressed. Complexity and inconsistency in terminology in past literature are likely to confuse investigators when they are recording, reporting, and retrieving the findings. In addition, a diagnostic algorithm adopting sufficiently integrated and updated findings is not readily available. By adopting a systematic review approach, this review attempted to redefine major trichoscopic findings and integrate their synonyms individually into the most frequently used terms besides identifying and discussing terms which potentially cause confusion. The findings are categorized into five subgroups: hair shaft, follicular, perifollicular, scalp findings, and hair distribution pattern abnormalities. The calculation of sensitivities and positive predictive values of such redefined findings was conducted by reviewing the descriptions in the past literature on major hair diseases, including alopecia areata, androgenetic alopecia/female pattern hair loss, telogen effluvium, trichotillomania, lichen planopilaris, frontal fibrosing alopecia, central centrifugal cicatricial alopecia, discoid lupus erythematosus, folliculitis decalvans, tinea capitis, and dissecting cellulitis, to confirm the diagnostically meaningful findings for representative diseases. This attempt redefined, for instance, yellow dots, short vellus hairs, exclamation mark hairs, black dots, and broken hairs as the findings of diagnostic significance for alopecia areata and hair diameter diversity, peripilar sign, and focal atrichia for androgenetic alopecia/female pattern hair loss. An updated diagnostic flowchart is proposed with the instructions to maximize its usefulness. Current limitations and future perspectives of trichoscopy as well as other emerging non‐invasive diagnostic modalities for hair diseases are also discussed.

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Hair Examination

Piraccini,

Bruni,

Starace

2023

European Handbook of Dermatological Treatments

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Utility of Horizontal Sections of Scalp Biopsies in Differentiating between Androgenetic Alopecia and Alopecia Areata

Cited by 7 publications

References 26 publications

A comparative study of histopathologic features in alopecia areata and pattern hair loss

A comparative study of histopathologic features in alopecia areata and pattern hair loss

Update on trichoscopy: Integration of the terminology by systematic approach and a proposal of a diagnostic flowchart

Hair Examination

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